A Collaborative Model for Reducing Hospital-Acquired Pressure Injuries
Pressure injuries remain a significant patient-safety concern across hospitals, rehabilitation services, residential aged care and community care. They can develop when sustained pressure, shear, moisture, poor nutrition or reduced mobility damages the skin and underlying tissue. The effects range from pain and delayed recovery to infection, longer hospital stays and increased costs for families and health services.
In Queensland, prevention depends on more than asking individual nurses to complete skin checks. Patients may move between emergency departments, surgical wards, intensive care, rehabilitation, residential aged care and home-based services. Each transition creates an opportunity for information to be lost, equipment to be delayed or a prevention plan to be applied inconsistently.
A collaborative model for reducing hospital-acquired pressure injuries across health services connects clinicians, researchers, consumers, carers, managers, procurement teams and information specialists. It turns evidence into practical routines that can be tested, measured and adapted across metropolitan Brisbane, regional hospitals and remote Queensland settings.
| Area | Fragmented approach | Collaborative approach |
|---|---|---|
| Risk assessment | Different tools and documentation | Shared assessment language and escalation criteria |
| Equipment | Ward-by-ward purchasing | Coordinated procurement and timely access |
| Data | Incident reports reviewed in isolation | Linked measures used for learning and improvement |
| Patient involvement | Advice given after admission | Patients and carers help shape prevention plans |
| Workforce capability | Irregular education | Ongoing training, coaching and feedback |
| Transitions | Verbal handover may vary | Standardised transfer of risk, skin and equipment information |
Why pressure injury prevention needs a system response
Hospital-acquired pressure injuries are influenced by clinical care, patient circumstances and the design of the health system. A person recovering from surgery may have limited mobility, reduced appetite and altered sensation. A patient with diabetes may have vascular or neurological complications, while an older person may arrive with fragile skin and an existing injury that is not clearly documented.
The risk can increase during busy periods, including winter respiratory surges and summer heat in Queensland. Humidity, sweating, incontinence and prolonged time in bed can affect skin integrity, while long journeys from regional centres to Brisbane may make repositioning and equipment planning more difficult. Prevention must therefore begin at admission and continue through every transfer.
The National Safety and Quality Health Service Standards, particularly the Comprehensive Care Standard, support systematic assessment, care planning and monitoring of risks. Health services can align their pressure injury programme with these requirements while also meeting local governance expectations, privacy obligations under the Privacy Act 1988 and relevant Queensland Health policies.
Build a shared prevention bundle
A prevention bundle should contain a small number of evidence-informed actions that are clear enough for consistent use. These may include a validated risk assessment, head-to-toe skin inspection, repositioning plan, pressure redistribution, moisture management, nutrition screening and referral to wound or tissue-viability specialists.
The bundle should be adapted to the patient rather than treated as a checklist. A person who uses a wheelchair may need a pressure-relieving cushion and a sitting-time plan. Someone receiving oxygen or non-invasive ventilation may need additional attention to device-related pressure. Patients who are sedated, critically ill or unable to communicate should have risks identified through observation, clinical history and carer input.
Shared protocols are most effective when they are co-designed across emergency, medical, surgical, intensive care, rehabilitation and community teams. A Brisbane hospital may have access to specialist wound clinicians and advanced support surfaces, while a smaller regional service may rely on telehealth advice and a limited equipment pool. The core standard can remain consistent while the delivery method reflects local capacity.
Make data useful at the bedside
A collaborative programme needs measures that show whether prevention is happening, not just whether an injury has been recorded. Useful indicators include the proportion of patients assessed within an agreed timeframe, completion of skin inspections, time to equipment delivery, repositioning-plan compliance and the number and severity of new hospital-acquired injuries.
Data should be reviewed with ward teams in a way that supports learning rather than blame. A rise in injuries may indicate a change in patient complexity, staffing, equipment availability or documentation practices. Reviewing cases across services can reveal recurring issues, such as delays after surgery, inconsistent device padding or incomplete handover to residential aged care.
Research partnerships can help health services test improvement strategies and evaluate whether they work for different patient groups. Lessons from collaborative maternal research demonstrate the value of connecting research institutions, clinicians and communities around a shared health outcome. The same translation approach can support pressure injury prevention through local audits, implementation studies and consumer feedback.
Include patients, carers and communities
Patients and carers often know which positions are comfortable, which movements cause pain and which routines are realistic at home. Their experience can improve prevention plans, especially when a person has communication needs, cognitive impairment, disability or limited English. Information should be offered in plain language and in formats that support informed participation.
Cultural safety is also essential. Aboriginal and Torres Strait Islander patients may move between urban, regional and remote services and may prefer family or community involvement in care decisions. Health services should work with Aboriginal health workers and local communities to make skin care, nutrition advice and discharge planning respectful and practical.
Culturally diverse communities may have different food preferences, health beliefs and experiences of healthcare. Work on group diabetes visits illustrates how shared, culturally responsive care can improve engagement with chronic disease management. Similar principles can guide pressure injury education for patients and carers.
Coordinate equipment, procurement and transitions
Pressure redistribution equipment should be available when it is clinically required, not several days after a risk has been identified. A service-wide equipment register can show where alternating-pressure mattresses, heel protectors, cushions, slide sheets and specialist seating are located. Coordinated procurement may also improve value in the Australian medical equipment market and reduce variation between wards.
Clinical teams should agree on how equipment follows the patient between settings. A person discharged to residential aged care may need a written prevention plan, current wound documentation and clear instructions about transfers, seating and follow-up. For patients returning to rural or remote communities, telehealth review and communication with local primary care can help maintain continuity.
Discharge planning should account for everyday realities, including long distances, limited transport, family caring responsibilities and the availability of home support. A prevention plan that depends on daily specialist review may be unsuitable outside a major centre. Simple instructions, reliable equipment and a named contact can make the plan more achievable.
Sustain capability and accountability
Education should be continuous and role-specific. Nurses need practical skills in assessment, repositioning and wound documentation; doctors need to recognise risk during diagnosis and treatment; allied health professionals can address mobility, seating and nutrition; assistants in nursing and support workers need confidence with safe repositioning and escalation.
Simulation, bedside coaching, orientation modules and short refresher sessions can reinforce learning during staff turnover. Health services can appoint pressure injury champions who connect ward teams with wound specialists, quality units and researchers. Regular feedback should include positive examples, unresolved barriers and actions assigned to accountable leaders.
Executive sponsorship is needed to protect time for training, fund appropriate equipment and review performance across the service. Brisbane Diamantina Health Partners can help bring together health services, universities, research institutes and consumers so that promising prevention methods move into routine practice and are evaluated in real Queensland settings.
Health services can begin by mapping the patient journey, agreeing on a common prevention bundle and identifying the first shared measures. Engage patients and carers early, connect ward leaders with researchers, and review progress through transparent clinical governance. Consistent action across hospitals and care settings can prevent avoidable harm, strengthen continuity and support better outcomes for Queensland patients and families.
